title: Treatment of recurrent high grade gliomas with hypofractionated stereotactic image-guided helical tomotherapy.
abstract: OBJECTIVE
  Salvage treatment of high grade gliomas that progress after standard therapy of resection and adjuvant chemoradiation therapy includes repeat surgical resection, second line chemotherapy, re-irradiation, or often a combination of the above. We present a series on patients treated with hypofractionated stereotactic image-guided helical tomotherapy and discuss the efficacy of this new technology in the treatment of high grade gliomas.
  
  
  METHODS
  Between June 2005 and August of 2008, eight patients with recurrent high grade gliomas were treated with salvage radiation therapy using hypofractionated stereotactic image-guided helical tomotherapy after image documentation of disease progression. Median age was 48.5 years with 4 females and 4 males. Median KPS at time of treatment was 65. All patients had either Grade III or IV gliomas at time of treatment with previous history of involved field fractionated radiotherapy. Median total dose given was 2500cGy in 500cGy fractions.
  
  
  RESULTS
  The median planning target volume was 69.5cm(3). Five of the eight patients were alive at the time of last follow-up with a median survival of 7.6 months. Radiographic documented control was seen in six of the eight patients with median local control of 4.6 months. Acute Radiation Therapy Oncology Group (RTOG) toxicity scores measured zero in all patients with only one patient requiring a reoperation following treatment.
  
  
  CONCLUSIONS
  Hypofractionated stereotactic image-guided helical tomotherapy provides an alternative to other stereotactic radiation therapy and radiosurgery options for treatment of recurrent high grade gliomas.
authors.affiliation: Hoag Memorial Hospital Presbyterian, USA. bkim@hoaghospital.org
authors.forename: Brian
authors.initials: B
authors.lastname: Kim
authors.forename: Emilie
authors.initials: E
authors.lastname: Soisson
authors.forename: Christopher
authors.initials: C
authors.lastname: Duma
authors.forename: Peter
authors.initials: P
authors.lastname: Chen
authors.forename: Russell
authors.initials: R
authors.lastname: Hafer
authors.forename: Craig
authors.initials: C
authors.lastname: Cox
authors.forename: Jim
authors.initials: J
authors.lastname: Cubellis
authors.forename: Annamarie
authors.initials: A
authors.lastname: Minion
authors.forename: Marianne
authors.initials: M
authors.lastname: Plunkett
authors.forename: Ralph
authors.initials: R
authors.lastname: Mackintosh
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016634:Radiosurgery / Q000379:methods*; D012008:Recurrence; D016879:Salvage Therapy; D016019:Survival Analysis; D020535:Video-Assisted Surgery / Q000379:methods*